RESEARCH SUPPORT FOR CULTURAL CONSIDERATIONS IN DIAGNOSIS

ABNORM – NORMS & DIAGNOSIS #3 PART 2

ZHANG ET AL 1998

Aim: explain differences in Chinese and Western rates of depression

Procedure: survey of 12 Chinese regions in 1993 of 19,223 people

Results: only 16 claimed to have a Western-style mood disorder sometime in

their life 4/5 of all psychiatric patients had ‘neurasthenia’ defined as ‘weakness

of nerves’ and derived from the traditional Chinese explanation for disease of Qi (a energy flow or life force imbalance)

Conclusion: Neurasthenia could be a Chinese variation of depression but it doesn’t fit the DSM definition

TSENG & HSU 1970

The Chinese are very concerned with the body and tend to manifest neurasthenic symptoms (exhaustion, sleep problems, concentration difficulties, etc.) similar to the physical aspects of depression and anxiety

OKELLO AND EKBLAD (2006) – LAY CONCEPTS OF DEPRESSION AMONG THE BAGANDA OF UGANDA In Uganda depression is seen as “illness of thoughts” and not a biological illness. Therefore, it is believed that depressed do not need medicine, unless the disorder is chronic or recurring.

KLEINMAN (1982) NEURASTHENIA AT A PSYCHIATRIC HOSPITAL IN CHINA

Aim: investigate if neurasthenia in China could be similar to depression in the DSM-III

Procedure: interviewed 100 patients All diagnosed with neurasthenia Structured interview format Used DSM-III criteria

Results: 87% could be considered suffering from depression

90% had headaches, 78% insomnia, 73% dizziness, 48% other symptoms Depressed mood given as main complaint only 9% of the cases

Conclusions Neurasthenia could be a cultural derivation of depression, except the symptoms

described are more somatic and less mood-oriented Clearly this comes from the cultural differences, diagnosticians should take care to

account for the cultural differences

LE-REPAC (1980) : CULTURAL BIAS OF THE RESEARCHER

Aim: Comparison between Caucasian and Chinese-American Therapists

Procedure: Five white and five Chinese-American therapists were compared in regard to their conceptions of normality, their empathic ability, and their perceptions of the same Chinese and white clients seen on a videotaped interview.

Results: (1) both therapist groups basically agreed in their conceptions of normality; (2) white therapists were more accurate in predicting self-descriptive responses of white

than of Chinese clients; and (3) there were significant differences between ratings of the same clients given by white

and Chinese-American therapists. Chinese clients were rated higher on a "Depression/Inhibition" cluster and lower on a "Social

Poise/ Interpersonal Capacity" cluster by white therapists than by Chinese-American therapists. Chinese-American therapists judged the white clients to be more severely disturbed than did the

white therapists.

Conclusion : Differences were interpreted as reflections of therapists' biases as well as their own world view.

KIRMAYER 2001

DSM IV includes suggestions for cultural interpretation of disorders, but still a Western outlook in psychopathology

BHUI 1999

– diagnostic systems are necessary for cross-cultural comparisons, so definitions of depression must fit psychiatric AND indigenous belief systems

JACOBS ET AL 1998

Procedure: sample of Indian women in a general practice in London

Findings: doctors were not likely to detect depression if the women did not detect all their symptoms due to cultural differences